Delirium, Fall, Hospital Acquired Condition, Immobility Syndrome, Mobility Limitation, Sarcopenia
Conditions
Brief summary
Immobilization in general internal medicine inpatients is a major contributor to morbidity and mortality. Goal-directed mobilization (GDM) may improve mobility. The aim of this study is to assess, if GDM increases physical activity (DEMMI score) during hospitalization and improves quality of care until 3 months after hospitalization.
Interventions
BEHAVIORALGoal-directed mobilization
* A short educational intervention with handout of a leaflet on GDM. * Definition of personal mobility goal level. * Communication of the mobility goal level to involved stakeholders. * Regular reassessment of the mobility goal level and booster sessions by physiotherapists.
Sponsors
University of Bern
Insel Gruppe AG, University Hospital Bern
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All consenting patients aged ≥ 18 years admitted to the Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland, who have an indication for physiotherapy (prescription by the resident in charge or the care coordinator). * Participants must be randomized at latest on the second day after hospital admission. * Written informed consent.
Exclusion criteria
* Inability to follow study procedures, i.e., due to language problems (unable to read, speak or understand German), psychological disorders, severe dementia (defined as to levels 5 - 7 in the Global Deterioration Scale), blindness, Patients unable to provide informed consent themselves * Expected hospital stay for \< 5 days * Medically indicated bedrest for more than 24 h, e.g. after surgery * Injuries or neurologic deficits of one or both lower extremities directly impairing walking capacity (e.g. fractures, hemiplegia, previous use of a wheelchair or bedriddenness) * Terminal illness * Pregnancy or breast feeding * Previous enrolment in this study * Enrolment of the investigator, his/her family members, employees and other dependent persons
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline of the DEMMI score | Day 5±2 | Change of the de Morton Mobility Index (DEMMI) score (range 0 to 100 with 0 indicating poor physical activity and 100 indicating a high level of independent physical activity) from baseline (at study inclusion), assessed by independent, blinded physiotherapist |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of re-hospitalizations and all-cause mortality | 3 months after study inclusion | By telephone interview with participant (if not available the patients next of kin or family doctor) |
| Independence during activities of daily living: change in Barthel index between (German version) | 3 months after study inclusion | By telephone interview with participant |
| Concerns of falling: change in Falls Efficacy Scale - International (FES-I, German version) | 3 months after study inclusion | Change (range 16 to 64 with 16 indicating no fear of falling and 64 indicating a high level of fear of falling) from baseline (at study inclusion), assessed by telephone interview with participant. |
| Quality of life: change in EuroQol (EQ-5D-5L, German version) | 3 months after study inclusion | Change (range from 0 to 100 with 0 indicating no problem and indicating 100 extreme problems) from baseline (at study inclusion), assessed by telephone interview with participant. |
| Change from baseline of the DEMMI score | Hospital discharge (max. day 14±2) | Change of the de Morton Mobility Index (DEMMI) score (range 0 to 100 with 0 indicating poor physical activity and 100 indicating a high level of independent physical activity) from baseline (at study inclusion), assessed by independent, blinded physiotherapist |
| Destination | 3 months after study inclusion | Destination may include: death, acute care hospital, rehabilitation, home, nursing home, others |
| Number of delirium episodes | During hospitalization (max. 14±2 days) | As recorded in the discharge letter and nurse's protocol |
| Number of in-hospital falls | During hospitalization (max. 14±2 days) | As recorded in the nurse's protocol (fall protocol) |
| Length-of-hospital-stay | 3 months | Length-of-hospital-stay |
| Total number of falls (with / without injuries) | 3 months after study inclusion | By telephone interview with participant (if not available the patients next of kin or family doctor) |
| Reaching MCID | Hospital discharge (max. day 14±2) | Reaching the minimal clinically important difference (MCID) of a change in DEMMI score (9 points) between baseline and discharge |
| Mobilization time | Day 5±2 | Mobilization time measured by accelerometer (i.e., time moving as total of time inactive and static, excluding time not worn) |
Countries
Switzerland
Outcome results
None listed